错过最佳手术时机永存动脉干患者的外科治疗  

Surgical Treatment for Patients with Persistent Truncus Arteriosus Who Missed Optimal Timing of Surgery

作　　者：王潇[1] 金晶[1] 陶凉[1] 周宏[1] 曾祥军[1] 周丹[1] 

机构地区：[1]武汉亚洲心脏病医院心脏外科,武汉430022

出　　处：《中国胸心血管外科临床杂志》2013年第3期269-272,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的评价错过最佳手术时机永存动脉干患者经一期手术修复的治疗效果。方法回顾性分析2003年6月至2011年8月武汉亚洲心脏病医院12例错过最佳手术时机的永存动脉干患者的临床资料,其中男7例,女5例;平均年龄4.5(0.6～14.0)岁;平均体重23(6～36)kg。所有患者均行一期手术修复。Van Praagh分型:A1型9例,A2型2例,A4型1例。合并冠状动脉起源异常2例,共干瓣中度反流2例,三尖瓣中度反流需要同期手术修复3例。所有患者术前均进行右心导管检查,均为重度肺动脉高压,平均肺循环血流量与体循环血流量之比(Qp/Qs)为2.42(1.50～5.26),平均肺血管阻力8.1(4～12)Wood U。所有患者吸氧试验反应均为阳性。右心室流出道重建采用带瓣管道7例、肺动脉直接连接流出道并前壁带瓣补片5例。结果全组无手术死亡。3例于术后监护时出现一过性肺动脉高压危象,经相应的处理好转。术后早期所有患者肺动脉测压显示:主肺动脉收缩压与桡动脉收缩压的比值为0.48±0.12。术后随访12例,平均随访时间48(12～91)个月。心功能(NYHA)Ⅰ级10例,Ⅱ级2例。1例因室间隔缺损残余漏合并右侧心力衰竭需要再次手术治疗;2例因肺血管阻力高及右心功能不全需要长期药物治疗。最近一次超声心动图显示:使用管道重建右心室流出道的患者,术后平均跨流出道压差为21(16～42)mm Hg;采用肺动脉与右心室流出道直接连接者术后平均跨流出道压差为18(10～28)mm Hg。没有因流出道梗阻需要二次手术的患者。肺动脉瓣反流均在中度以内。有冠状动脉起源异常的2例患者术后随访期间未出现心肌缺血及相应心电图表现。结论即使对已经错过最佳手术时机的永存动脉干患者,手术治疗仍然可以获得良好的近-中期效果;但远期还需要随访观察共干瓣膜反流以及右心功能状况。Objective To investigate clinical outcomes of one-stage repair for patients with persistent truncus arter- iosus who missed optimal timing of surgery. Methods We retrospectively analyzed clinical data of 12 patients with persistent tnmeus arteriosus who had missed optimal timing of surgery and were admitted to Wuhan Asia Heart Hospital between June 2003 and August 2011. There were 7 male patients and 5 female patients with their median age of 4.5 （0.6-14.0） years and median body weight of 23 （6-36） kg. All the patients underwent one-stage surgical repair. There were 9 patients with Van Praagh type A1, 2 patients with type A2, and 1 patient with type A4 persistent truncus arteriosus. There were 2 patients with anomalous origin of coronary artery, 2 patients with moderate truneal valve insufficiency, and 3 patients with moderate tricuspid valve insufficiency which required concomitant surgical repair. All the patients received preoperative right heart catheterization which showed severe pulmonary hypertension. The median pulmonary-systemic blood flow ratio （ Qp/Qs ratio ） was 2.42 （ 1.50-5.26 ）, and median pulmonary vascular resistance was 8.1 （ 4-12 ） Wood units. All the patients showed a positive pulmonary vasodilator response to oxygen. Right ventricular outflow tract （RVOT） reconstruction was achieved using a valved conduit in 7 patients and a valved patch in 5 patients. Results There was no in-hospital death in this group. Three patients had transient pulmonary hypertensive crisis during postoperative intensive care and were healed after proper treatment. Early postoperative pulmonary artery pressure monitoring in all the patients showed that main pulm- onary artery systolic pressure/radial artery systolic pressure was 0.48±0.12. All the 12 patients were followed up for 48 （ 12-91 ）months, There were 10 patients with New York Heart Association （NYHA） class I and 2 patients with NYHA class Ⅱ during follow-up. One patient received reoperation for residual ventricular septal def

关 键 词：动脉干 永存 高肺血管阻力 外科手术 

分 类 号：R654.2[医药卫生—外科学]